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Fetal Surgery Is Coming of Age, Nurses Report

June 6, 2012 — Maternal-fetal care is entering a new era. Highly sophisticated surgical teams now repair spina bifida and other birth defects in the womb, place fetal shunts to treat life-threatening congenital conditions, and perform minimally invasive procedures in the mother’s uterus to treat complications in fetal twins.

These are examples of the still-emerging, complex field of fetal surgery, which has previously yielded relatively little published research on best practices in nursing care.

“Nurses are in a crucial position to care for mothers, fetuses and newborns as fetal interventions expand,” said Susan R. Miesnik, MSN, CRNP, the guest editor of the In Focus section of the May/June 2012 Journal of Obstetric, Gynecologic & Neonatal Nursing.

The new issue of the journal has a special focus on fetal surgery. Miesnik is a perinatal nurse practitioner at the Center for Fetal Diagnosis and Treatment at The Children’s Hospital of Philadelphia, one of a handful of comprehensive fetal surgery programs in the world. Miesnik and her colleagues in the field, including 10 from Children’s Hospital, review the latest nursing practice in this field in four articles.

The Center for Fetal Diagnosis and Treatment was in the spotlight in Feb. 2011, as one of the lead centers that reported highly encouraging results from the MOMS trial, the landmark, seven-year-long, federally sponsored clinical trial of fetal surgery for spina bifida. An article in the journal reviews the nurse’s role in coordinating care for women, fetuses and newborns undergoing this pioneering treatment.

Another article reviews the history of fetal therapy, starting with laboratory research 20 to 30 years ago and describing current treatments for a growing number of prenatally diagnosed conditions. A separate article focuses on nursing care in the placement of fetal shunts for lower urinary tract obstructions, lung lesions and other problems. The fourth review article in the series covers the range of complications related to identical twin gestations, such as twin-twin transfusion syndrome, in which abnormal blood vessel connections cause one fetus to grow at the expense of its twin.

“As the field of fetal medicine continues to advance, more and more babies are being treated before they are born, and as pioneers in the field, it is crucial that we share this important information with our nursing colleagues across the country and around the world,” added Miesnik.